Veterinary dermatologist Dr. Ashley Bourgeois returns to shed light on a topic often overlooked in veterinary care: dermatology issues in cats. Dr. Andy Roark and Dr. Bourgeois discuss the nuances of feline dermatology, emphasizing the challenges and underrepresentation of cats in dermatological care. They dive into common symptoms, diagnostic approaches, and effective treatments, providing valuable insights into managing allergies and skin conditions in cats. This conversation includes effective communication and expectation setting with clients in order to increase compliance. Tune in to another episode packed with practical advice and innovative solutions for veterinary professionals looking to enhance their dermatological care for feline patients. Gang, let’s get into this episode!
You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!
LINKS
The DermVet: https://thedermvet.com/
Uncharted Veterinary Podcast: https://unchartedvet.com/uncharted-veterinary-podcast/
Dr. Andy Roark Charming the Angry Client Team Training Course: https://drandyroark.com/charming-the-angry-client/
Dr. Andy Roark Swag: drandyroark.com/shop
All Links: linktr.ee/DrAndyRoark
ABOUT OUR GUEST
Dr. Ashley Bourgeois is a board-certified veterinary dermatologist passionate about providing practical knowledge to general practitioners to help itchy pets! She completed her bachelor’s degree at Iowa State University and graduated from the University of Missouri’s College of Veterinary Medicine in 2010. She then completed a one-year small animal internship at Purdue University. Upon finishing her internship, she accepted a residency position with the Animal Dermatology Clinic’s Tustin, California location in 2011. She became a Diplomate of the American College of Veterinary Dermatology in 2014. Dr. Bourgeois moved to Portland, Oregon in 2016 to help expand the company. She is an owner within the company and on the board of directors. She has a strong interest in autoimmune skin diseases, allergies, cytology, and otology.
In her leisure, Dr. Bourgeois enjoys outdoor activities, traveling, and watching sports. She and her husband stay busy with their daughter, son, and rescue Lab/Boxer/Pit mix. Dr. Bourgeois is passionate about educating veterinarians in dermatology and work/life integration through her podcast, lecturing, and social media presence (The Derm Vet).
EPISODE TRANSCRIPT
Dr. Andy Roark: Welcome everybody to the Cone of Shame veterinary podcast. I am your host, Dr. Andy Roark. Guys, I am here with veterinary dermatologist and good friend, Dr. Ashley Bourgeois. Ashley is on the podcast today. Guys, we are talking about our top tools for cats when it comes to dermatology cases. Guys, I don’t think cats get enough love
when we do allergy and derm workups, honestly, and so I want to talk about that with Ashley and we dive right into it. Gang, let’s help some itchy cats by getting into it.
Kelsey Beth Carpenter: (singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark: Welcome to the podcast, Dr. Ashley Bourgeois how are you, my friend?
Dr. Ashley Bourgeois: Dr. Andy Roark, I am so good. Very excited to be back on the podcast.
Dr. Andy Roark: It’s great to have you here. For those who don’t know you, you are you are a longtime friend of mine. You are a veterinary dermatologist. You lecture all over the world on veterinary dermatology. You are at the Animal Dermatology Clinic in Portland, Oregon. You’ve been on the podcast many, many times.
You have, you’re a, you’ve got articles. You just, you just do a ton of stuff, Ashley. I wanted to ask you about something today and you’re always so gracious with your time. You know, it’s it’s summer as we’re recording this and I’m in the south and so summer means allergies and lots of ear infections and itchy skin and things like that.
And so I was wondering if If you would be up for talking with me a bit about the tools in our toolbox for dealing with dermatology problems in cats. I feel like derm and cats does not get a whole lot of spotlight, and I always like to kind of run back through the toolbox and make sure that I know what I can do, and make sure that I’m aware of all my options in trying to help out our cats because I don’t think know that they get as much care in dermatology as they probably should.
So, let me actually, let me just pause there and start with that. Do you agree with that? Do you think that cats are underrepresented in our dermatology caseload? Or do you think that they’re just less likely to manifest problems?
Dr. Ashley Bourgeois: totally think they’re underrepresented and I think there’s kind of a few different layers to that. Like I think one, owners don’t recognize it as readily, right? Like if a dog’s going to have an allergic flare, they’re going to slurp their paws next to you. A cat’s going to go hide and all of a sudden have a bald belly and cats are naturally groomers.
So it’s really easy for owners to think, well, they’re licking their belly, but that’s normal because they’re groomers. I also think just because we are more limited on what we have available for cats that, you know, we kind of want to give up on them a little bit easier. Like, well, sorry, that’s what I got and that’s it.
But there’s so many simple things that we can try to get these cats more comfortable and they deserve to be comfortable. You know, we should still be working with our cat clients. So that we can provide comfort for these itchy cats.
Dr. Andy Roark: Do you think we make assumptions about what cat clients are willing to do with their cats?
Dr. Ashley Bourgeois: Totally. I totally think that we make assumptions and sometimes they’re true,
Dr. Andy Roark: Yeah,
sure.
Dr. Ashley Bourgeois: but there are really good about giving medications or doing the things with them.
Dr. Andy Roark: Start to unpack the toolbox for me a little bit. So, we, we’ve got allergies in cats. First of all most common presentations of allergies in cats. What are we talking about? Like, what do you think gets overlooked?
Dr. Ashley Bourgeois: Yeah. I would say that if we think about the most common things, bald belly cats are probably pretty high up there. So they just come in, they’re coming in for your wellness exam as a GP. And then you just look at them and start to notice they’re kind of thinning on their belly. And again, because they’re naturally groomers, owners don’t think much of it.
We also see a lot of head and neck itchiness. So they’ll kind of like really scratch their head and neck and they’ll have excoriations all over. And then of course the different representations of eosinophilic granuloma complex, which I think those are kind of tricky because the oral lesions, a lot of owners don’t look for unless they’re actually showing us symptoms.
So I always try to encourage vets to try to do oral exams and cats if they’re accepting of it, because you’ll be surprised what you can find.
Dr. Andy Roark: Yeah, it’s funny. I, I always do my absolute best to do oral exam on cats. I don’t ever think about it as an allergy check. But it makes, I mean, it, it totally makes sense.
Dr. Ashley Bourgeois: It doesn’t have to be crazy things. People think like the weird pictures of like this nasty eosinophilic granuloma we put up, but it’s very common just to find like really little rodent ulcers right here. So I’ll just, even if they won’t let me do full exam, I try to like lift their lips up and just see if there’s any like signs of a beginning of a rodent ulcer.
Because that’s gonna confirm to me that we probably have some sort of allergy going on.
Dr. Andy Roark: Just kind of along the front
Dr. Ashley Bourgeois: gums?
Mm hmm.
Dr. Andy Roark: Okay. Yeah. That totally makes sense. Okay, so when you see that, you see the ball belly, you see sort of rodent ulcers, things like that. you’ve got some idea that we’ve got some sort of an allergy problem going on. Where do you start to go from there?
How do you, how do you sort of approach this?
Dr. Ashley Bourgeois: Can I tell you a secret for most dermatologists when we are talking about itchy cats? We are so excited if they just present to us on good quality flea control. That sounds incredibly simple, but I’ll tell you what, I think I diagnosed three flea allergic cats last week. So like we, yeah, we get them all the time and we’ll see kind of, you know, the exam like flea comb, no fleas and,
that’s our first step because to me flea, flea allergies are very common in cats. Even if they’re indoor, I have diagnosed them in indoor cats in Southern California, living on a high rise in Los Angeles. Like we see flea allergy fairly commonly. It’s called a cat flea, right? Like the flea wants to be on cats, but ultimately if they come in already on good, Isoxazoline flea preventions, what there’s quite a few options in cats.
If they come in on that and they’re still showing symptoms. It is just a huge step that I don’t have to waste the time and money and effort into for that initial exam. And that includes everyone in the household. That’s the other thing we see is like the itchy cat will be on flea control, but not the other animals in the household.
And I have actually had many cases where if we just treat all the other animals, that cat gets better.
Dr. Andy Roark: How did these cats present? Because, Ashley I would say, you know, when I look at cats and they’ve, and they have flea allergy stuff, it’s always that sort of racing stripe up the back, not always, but in my mind, it’s almost always that racing stripe, you know, the triangle above the tail and the dorsal aspect of the, of the lower back, Is that how these cats are presenting as well, or are you seeing I’m a little bit perplexed at, at flea allergy cats showing up with a dermatologist. I guess, being honest, I think that’s why I’m kind of asking this question.
Dr. Ashley Bourgeois: Yeah, all of the above. So racing stripe for sure. We like to say if a cat’s not wearing pants, meaning that they’re hairless, like on the caudal thighs, rump belly, I’ve had them just do the ball belly. I’ve had them completely be ripping their entire, I mean, I have videos of a case completely obliterating itself in the, in the clinic. Just completely hairless,
had came in on a flea collar, but not a good quality flea control. And then within two months, that cat was on nothing, but flea prevention and has been completely controlled now for three years, just on flea prevention. So they really can do present in a lot of ways, but yes, a lot of times if they have that racing stripe, if they don’t have hair towards the backend, you think of it.
But even if you have to remember two, cats like to get more than one allergy. So, even if you don’t get them fully under control by having them on good flea prevention, as a dermatologist, when I go to work that case up, I just can get that out of my mind that there’s even a component of it, right? Like if they’re food and flea, if I just know we’re on good flea prevention, I’ve crossed that bridge and we can focus on everything else versus they’re both of those, but we keep having to give them steroid injections because we don’t control one aspect of their disease.
Dr. Andy Roark: Right. Okay. That makes sense. So, flea medication seems like a great place to start.
Dr. Ashley Bourgeois: Yes, please. Please, please, please. We do. We see it quite often, which I think surprises a lot of people. But we actually get a ton of flea allergic cats in our clinic and we feel bad because they have to wait to see us. We’re more expensive and it’s something like pretty straightforward.
Dr. Andy Roark: What else do you like to go to?
Dr. Ashley Bourgeois: Yeah, so then I would say we assume they have good flea control, then we’re starting to think of, to me, kind of two things. Like one, how do we make them comfortable? And then two, how do we continue to work them up? So there are some important things to realize about feline allergies, one of them being distribution.
So there has been a study, a multicenter study, that showed if cats tend to scratch towards their head and neck pretty frequently, that they’re a bit more likely to have food allergy as a indication of their itchiness. So if they are really exhibiting that kind of head and neck itchiness, then, and I know they’re on good fleet control, then that’s usually my next step.
And you have to be really willing to work with clients over, you know, what they’ll feed, can they be strict if they have multiple cats, is that possible for them? And so then we kind of dive into that discussion. To rule out a food allergic component. Many cats don’t have abnormal gastrointestinal signs.
So even if they seem to be defecating normally, not really vomiting, they can still be extremely itchy from a food allergy. And so the, to me, if I can get any cat under control with flea control, indoor food, long term and not have to give them oral medications. You know, I’m very happy for that owner. Then assuming that portion we’ve got under control and we’re going to go down the feline atopic skin syndrome, which if you don’t know, that is the official name for environmental allergies and cats, which is kind of long and complicated, but it just is meant to be a representation of how crazy their allergies can present.
If you think about environmental allergies and cats, it can be anything from, I have a rodent ulcer eating my front lip, to I have asthma, to I get itchy all over my body. So they just present in so many different ways. Then we’re going to work on making them comfortable, but really be trying to drive them to allergy test and do immunotherapy.
Because that’s one of the main ways we can start limiting how many oral medications they can take longterm if we can help it.
Dr. Andy Roark: Jumping back real quick, I have always had the impression, I’ll just say, for me, it has been substantially harder to get cat owners to go in, in a way I believe, on on diet trials. Then it has been for dog owners. Have you seen that as well? I mean, I don’t know if it’s true or the perception is just oh, well she’s only gonna eat what she wants to eat or she has this specific food that she demands. I don’t tend to get that much pushback.
There may be pushback about price or things like that for dogs, but there’s I’ve, I’ve had such challenges in getting pet owners to buy in and do a food trial in cats. I’m assuming by the time, you know, if we have someone who’s come to the dermatologist, they’re probably more open to, to advice maybe than the general populace.
But have you found that to be true at all? And if so, how do you sort of approach that conversation of getting the owners to say, Okay, we’ll, we’ll try a different diet even though, even though, you know, Fluffy really loves her Frisky’s diet.
Dr. Ashley Bourgeois: Yeah. I think there’s probably some truth to that. I mean, I certainly have dog owners who are still hesitant or we get finicky dogs, but we know cats are kind of like little aliens, right? They kind of, They make the rule book and we’re just there to live in their world. So there’s a couple of tips I do.
One, I say like, what do they like? What do they need? I have my preferences on diets, but there are some limitations, right? Like Ultimino is great, but if they need a wet food that doesn’t have a wet food. So then I need to kind of consider other options of, okay, if we’re going to go novel protein, that’s fine, but then I have to know what they’ve been on so I can make sure it’s actually novel for them.
So I start out by asking like, what is it your cat does tend to prefer? Do they need a wet? Do they need a stew? Do they need a treat? Are they fine with just kibble? Are there other cats in the household that have nutritional needs and can you keep them strict? So, you know, if, if we can, ideally you just put all the cats in the household on it, but that’s not always the case.
If we have a cat who has renal disease that we can’t ignore just because we’re trying to do a diet trial and another cat. So then I just make sure one, we don’t have nutritional needs of another cat we have to consider. And then three, the way that I think I have a decent job, I still get people who won’t do it, but a decent job at getting people to do diet trials is I give them the end point.
I think we really need to focus on the fact that this is a diagnostic test. You know, if we just say, Oh, we’re just switching the food. I think people visualize forever, right? They visualize like, Oh, well now I have to buy this really expensive food. And the friskies is like my love language to the cat.
And you’re taking that away forever. And I’m like, I’m not, I need eight weeks. I need eight weeks. Because if the, if Fluffy is no better for this diet change, cool. I can feel comfortable knowing we’re not missing something. We move on from food. If we get through eight weeks and the diet has made a huge difference, that doesn’t mean we can’t feed anything else the rest of Fluffy’s life.
We just know what baseline looks like and then we can kind of add the other fun things back in and see what makes them flare and what doesn’t. So I think really giving a finite amount of time is super helpful.
Dr. Andy Roark: I really like that a lot. That’s it’s a much smaller ask to say we’re gonna do this for eight weeks and eight weeks It’s not an intimate substantial amount of time, but it feels like a Defined thing that okay, we’re gonna do this So my my dog is wearing the elizabethan collar right now cuz he got he got a he got his teeth cleaned and he got wart taken off of his leg and he will pull the stitches out immediately if he can and I feel bad for him. You know, he doesn’t understand.
He bangs it. He’s that dog that just refuses to acknowledge he’s wearing it. So he like hits, you know hits the doorframe and he’ll take you out, you know paste that thing into your shins and The fact that it’s going to be ten days makes it all Absolutely doable. If it was kind of like, let’s just see if this helps and maybe he’ll wear it forever, I would be, I would be out.
But knowing that we’re going to do this, I’m going at the end of this time, we will have accomplished something and that will be over. And so I love your point of we do this for eight weeks and then we’re going to know some things and we will have that information. I think that’s, that’s, that makes a lot of sense.
Dr. Andy Roark: Talk, talk to me a little bit, Ashley, about About comfort of the cats and specifically sort of itch control while this is going on So we’ve got this cat and they’re coming in and they’ve got the bald belly or they’ve got you know You know evidence of scratching around their neck and things like that and you say well, you know I want to try this diet trial or you know I think this may be feline atopic skin syndrome and and we’re gonna set you up for some allergy testing with the dermatologist. What are you doing for comfort for these cats,
while you’re doing this? Are you, are you doing anything or are you concerned that what you do is going to negate the efficacy? You know what I mean? If I, if I do a steroid injection and then send them out to do a diet trial, they’ll go, oh my gosh, she immediately is better. And I go, well, is she better?
Or are we still, are we riding out this, this other, you know, medication that I gave? Something like that. So help me sort of understand that.
Dr. Ashley Bourgeois: Yeah, I mean I still use a decent amount of steroids in cats to be honest because they get quick relief as long as they’re not a contraindication based on their other comorbidities. I don’t use a ton of injections, but a lot of that is just because by the time they come to me, they’ve kind of gone that route, right?
Like, they’re, they’re trying to get away from that, they can’t really do that as often. So I do tend to use a bit more oral steroids, and I work with owners to kind of get them to take that. But I still think they deserve to be comfortable. You can not send them out the door saying, here’s your bag of food.
See you in eight weeks. Like they’re going to call you in a week and be ticked off. So ultimately you still need to make them comfortable. When I started a steroid, I’ll tell owners, like if they’re great in a couple of days, this is steroid, not the food. But I, the way that we figure out if the food is helping is to get them off the steroid eventually.
And then a lot of the answers in the challenge, right? Because your two months, it’s a long time. You could switch seasons, like a lot of other things can happen. So when owners ask, well, how are we going to know? I’m like, well, no, because we’ll try to stop the steroid and we will try to ultimately challenge that diet.
I also just want to stress the importance of really the thing that only thing we have on label for cats for allergic itch is a topic and we still use a ton of cyclosporine in cats and it can work very, very well, I think some things that people forget is that you can use the capsules in cats. So the liquids on label, and that’s what’s kind of marketed for cats.
But I asked cat owners like what’s easier for you, a liquid or a capsules. You will be surprised how many cat owners actually will prefer capsules. Now they’re not the smallest capsules in the world. So we have to be honest about that. But the liquid has a bitter taste to it. So if I’m going to utilize cyclosporine, I kind of ask them for a starting point.
Like, which one do you think you’d be have more success with giving? And if that doesn’t work, we can go to the other one.
Dr. Andy Roark: Yeah. So, I really like what you’re doing here. The emphasis on the challenge makes a ton of sense to me. Because if you say, the emphasis is on the elimination part, then that’s always the question for me is, well, if I, if I send them home on steroids and then the, you know, it’s springtime and we, you know, very quickly, you know, things fall apart.
flare up. I can’t, you know, I’m all snotty and, and congested for seven days, 10 days, something like that. And then I kind of move on. You go, well, if it’s just the diet trial, I still question, you know, what, what did we actually learn here? I like the idea that the whole time you’re telling them, we are going to challenge
when we get to the end. I think that that’s I, I just, I like how you stage it and, and go ahead and set them up for that. I, I will say, I have been guilty in the past of saying, let’s try this other diet and we’ll do a sort of a diet trial, quote unquote, and let’s see how it goes. And then they say, well, it’s, you know, it’s great.
It’s working great. And I said, well, let’s just go on and not come back and done the trial or the challenge to actually say, oh, yep. When we. When we did challenge, we got this response and now we, now we know this. And so I, I like that you set that expectation at the very beginning. When we’re talking about sort of comfort and itch control and things like that, if the plan is to do some sort of allergy testing, things like that, talk to me a little bit about what is, what is safe for me to intervene with to sort of provide comfort before we do this allergy testing versus where am I potentially hampering the test?
Dr. Ashley Bourgeois: So that’s a really great question and something that’s very individual on the dermatologist. So one thing I would suggest is if you have a local dermatologist in your area that you’re going to be referring to checking in with them, I can give you kind of the general synopsis for me. You know, for if we’re going to serum test, so cats notoriously do not pop up their skin tests very well.
So it’s kind of hit or miss if dermatologists will skin test them. Something that we have been doing and is reported in the literature, but not everyone does is something called IV fluorescein. So you actually skin test a cat. You have to do it fairly quickly. So you have to have yourself or staff trained in it.
And then you actually give a little bit of IV fluorescein through a catheter, and then you read it with a black light and it enhances their positives. Now again, not everybody does that, but more and more people are starting to do that and we’ve had some pretty good success with that. There are some people that will prefer serum tests just because cats don’t tend to, again, pop up their positives.
Like dogs, like horses are like the best dogs are kind of next. And then cats like. Again, they like to be difficult. For a lot of the serum panels you and there’s pros and cons to all of them. They’re the steroids and cyclosporine, things like that don’t really have a huge effect on them. So I don’t personally get too worried if someone refers me to them and we’re just going to serum test for whatever reason.
I preferably try to do both. That’s an individual preference. If finances aren’t an issue, just to collect as much info as possible for my skin tests, they can’t be on steroids. So they would have to be off of steroids for at least a month, usually is our preference. So if they get a long acting injection, say like depo, right, that could actually be a few months because it’s in their system for a couple of months.
So cyclosporine though, if you are using off label Apoquil. You know, to our knowledge, there’s not a huge impact on skin testing. So steroids and then antihistamines, if you are using an antihistamine, depending on how long they’ve been on it, most of us say like one, two weeks, they need to be off of it before we can skin test.
There’s not a huge impact though on serum testing.
Dr. Andy Roark: There’s always been a bit of a question, I think, around serum testing. I, I think in, in just, and this is over the last year, 15 years or so. So, overall, you, you seem to be, to be positive on the, on the benefits of serum testing. And it sounds like, you know, depending on the panel that you choose, results and mileage may vary.
When I have pet owners that come to me and asking about serum testing, what kind of general guidance would you give to them as far as efficacy, a worthwhile investment, things like that?
Dr. Ashley Bourgeois: Yeah. So ultimately if you use some of the more like quality serum panels first of all, food’s not there. So there’s some interesting research being done in food, but we never suggest it as like a diagnostic test. So we don’t run food panels, but if you’re just looking at environmental, the couple of things I can tell you is one.
We utilize those results to help us formulate immunotherapy, but you still, it’s not a, Oh, that’s a high number. So that’s automatically what goes in. You’re still supposed to be evaluating like their history, their seasonality cross reaction. So there’s this weird art form that goes into it. And if you want to start a fight at a derm conference, ask about serum versus skin testing, because there’s a lot of opinions and there’s a lot that we just honestly are still discovering and don’t know, which is why I will try to do both,
if I can. Because I think there can be some different value in both of those tests. But another important thing to realize is please don’t allergy test them unless they are committed to immunotherapy because it’s not the cheapest test and we want to be able to utilize that information to help that pet.
And if that’s not going to be in their wheelhouse, the finances are better off with the symptomatic treatments because allergies are very expensive.
Dr. Andy Roark: Yeah, that, that totally makes sense. Help me set expectations around immunotherapy. So if I have a pet owner and they’re like Yeah, you know, I would consider immunotherapy. What does that, what does that involve? How do you talk to them about what they’re getting into?
Dr. Ashley Bourgeois: Yep. So for immunotherapy, I think it’s a great option in cats because a lot of cats are actually very accepting of injections, though there is sublingual forms, and I have some cats who do great on that as well. It’s just given more often than the injections are long term. I tell owners there’s about a 70 percent success rate, and that’s pretty consistent throughout the literature.
Now, when I say 70 percent success rate, that does not mean there’s a 70 percent chance or just off of everything, but there’s a 70 percent chance we’re going to see benefit. So benefit could be, okay, we were even on cyclosporine, you know, in all the things we’re still pretty itchy in a year. Oh, we need cyclosporine, but now we’re actually responding quite well with the addition of immunotherapy.
Or I’m a cat who used to break out with pyoderma. Yeah. Seven times a year. Now I really only break out like one time of year. So there’s a lot of different ways that we kind of judge benefit. I really like to simplify things for owners. So I like to tell owners, if we’re going to make this decision, an allergy test that I have a students, B and C students and F students and a student is within a year, that’s all you really need.
And that’s our dream for every patient. Like you you’re off the steroids. You’re off the cyclosporine. You know, if you’re just immunotherapy and flea control, That would be amazing and very safe. We get a lot of B and C students and B and C to me is I still need some help, but I am better. So I still need some cyclosporine maybe in the spring, but I am much better than I was when I was not on immunotherapy.
We do unfortunately have about 30 percent of F students. Like we put the time effort money into it and we just don’t see any benefit. And that’s really hard to ask an owner to commit to something for a year, year and a half. And there’s not a guarantee to work, but we do know cats tend to respond really well.
They tend to be very accepting of it. And that’s one of the only natural therapies we have to truly work with their immune system. So they don’t keep progressing their disease.
Dr. Andy Roark: Yeah, well, 30 percent is not an inconsequential number. I think you’re, I think you’re really smart to make sure we’re setting these expectations up front at the very beginning of, hey, you know, there’s almost a one in three chance that, that after a year and a half, we’re not going to, to see improvement here.
I could see that absolutely being quite frustrating, but at least going in, they have to know it’s an option on the table. I think, I think that’s I think that’s just smart communication. Ashley Boussois, thank you so much for being here. Where can people find you online? You do great social media stuff.
Where, where should I send them?
Dr. Ashley Bourgeois: Oh, thank you. I am simple. I keep everything under the derm fat. So I’m strongest on Instagram. I also have a weekly podcast that just goes over dermatology information. And then, as you said, I’ve been enjoying being back on the lecture circuit. So hopefully continuing to do lots of conferences in person.
Dr. Andy Roark: Thank you so much for being here. And guys, thanks for tuning in and listening. Take care of yourselves, everybody. And that’s what we got. Guys, thanks for being here. Thanks to Ashley for being here. If you enjoyed the podcast, share with your friends or leave me an honest review wherever you get your podcasts. It means the world to me. It’s how people find the show. So anyway, thanks for that. Take care of yourselves, everybody.
I’ll talk to you later on.
